Request for Payment of Federal Benefit by Check, EFT Waiver Form

ICR 201405-1510-002

OMB: 1510-0077

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
Modified
Supporting Statement A
2014-06-03
Justification for No Material/Nonsubstantive Change
2014-05-22
IC Document Collections
ICR Details
1510-0077 201405-1510-002
Historical Active 201401-1510-001
TREAS/FMS
Request for Payment of Federal Benefit by Check, EFT Waiver Form
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/03/2014
Retrieve Notice of Action (NOA) 05/22/2014
  Inventory as of this Action Requested Previously Approved
07/31/2015 07/31/2015 07/31/2015
3,250 0 3,000
1,083 0 1,000
1,380 0 1,380

31 CFR part 208 requires that all Federal non-tax payments be made by electronic funds transfer (EFT). This form is used to collect information from individuals requesting a waiver from the EFT requirement because of a mental impairment and/or who live in a remote geographic location that does not support the use of EFT. These individuals may continue to receive payment by check. However, 31 CFR part 208 requires individuals requesting one of these waiver conditions to submit a written justification.

US Code: 31 USC 3332 Name of Law: Required Direct Deposit
  
None

Not associated with rulemaking

  76 FR 77590 12/13/2011
77 FR 26605 05/04/2012
No

2
IC Title Form No. Form Name
EFT Waiver Form FMS 1201W (SP), FS Form 1201W Solicitud Para Recibir Su Pago de Beneficios Federales En Cheque ,   Request for Payment of Federal Benefits by Check
EFT Waiver Form - DFAS FS Form 1201W-DFAS Request for Payment by Federal Benefits Check

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 3,250 3,000 0 250 0 0
Annual Time Burden (Hours) 1,083 1,000 0 83 0 0
Annual Cost Burden (Dollars) 1,380 1,380 0 0 0 0
Yes
Miscellaneous Actions
No
The Defense Finance and Accounting Service (DFAS) has asked Treasury to assist them in reviewing and approving or rejecting requests by their recipients of a military benefit to continue receiving payment by check. The DFAS has requested minor changes to the form to accommodate the use by this category of recipient. The Bureau of the Fiscal Service (FS) will offer DFAS users the FS 1201W-DFAS, which is the same as the FS-1201W except for a few modifications to accommodate military benefits recipients. A check box selection for the type of recipient receiving the military benefit has been added and the recipient would identify the social security number of the deceased person if annuitant or former spouse. We estimate an additional 250 DFAS respondents and an additional 83 burden hours.

$1,320
No
No
No
No
No
Uncollected
Wesley Powe

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
05/22/2014


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